scholarly journals Elevation of troponin values in differential diagnosis of chest pain in view of pulmonary thromboembolism

2012 ◽  
Vol 69 (10) ◽  
pp. 913-916 ◽  
Author(s):  
Rada Vucic ◽  
Slavko Knezevic ◽  
Zorica Lazic ◽  
Olivera Andrejic ◽  
Dragan Dincic ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Differential Diagnosis ◽  
Heart Disease ◽  
Chest Pain ◽  
Muscle Injury ◽  
Clinical Presentation ◽  
Pulmonary Thromboembolism ◽  
Coronary Syndrome ◽  
Electrocardiographic Abnormalities ◽  
D Dimer

Introduction. Acute coronary syndrome, as unstable form of ischaemic heart disease, beside clinical presentation and electrocardiographic abnormalities, is characterized by increased value of troponin one of cardiospecific enzimes. Although troponin is a high specific and sensitive indicator of acute coronary syndrome, any heart muscle injury may induce its increasing, so there are some other diseases with the increased troponin value. Case report. We presented a female patient with chest pain, admitted because of suspicioun of acute coronary sindrome. Performed coronarography excluded ischemic heart disease. Considering symtomatology, electrocardiographic abnormalities, increased troponin and D-dimer values, as well as echocardiography finding we considered pulmonary embolism as a differential diagnosis, which was confirmed by pulmoangiography. Conclusion. Isolated increased troponin values are not enough for diagnosis of acute coronary syndrome.

scholarly journals Impact of D-Dimers on the Differential Diagnosis of Acute Chest Pain: Current Aspects besides the Widely Known

2014 ◽  
Vol 8s2 ◽  
pp. CMC.S15948 ◽  
Author(s):  
Kathrin Hahne ◽  
Pia Lebiedz ◽  
Frank Breuckmann
Keyword(s):  
Acute Coronary Syndrome ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
Cost Effective ◽  
Coronary Syndrome ◽  
Age Related ◽  
Acute Aortic Syndromes ◽  
High Negative Predictive Value ◽  
D Dimer

D-dimers are cleavage products of fibrin that occur during plasmin-mediated fibrinolysis of blood clots. In the emergency department, D-dimer measurement represents a valuable and cost-effective tool in the differential diagnosis of acute chest pain including the main life-threatening entities: acute coronary syndrome, pulmonary embolism, and acute aortic syndrome. Whereas the diagnostic and prognostic values of D-dimer testing in acute coronary syndrome is of less priority, increases of D-dimers are frequently found in venous thromboembolism and acute aortic syndromes, especially acute aortic dissection. As to the high negative predictive value of D-dimer in those disorders, patients with low to intermediate pretest probability may profit in terms of less necessity of further non-invasive or even invasive imaging, simultaneously reducing potential complications and healthcare-related costs. However, because of the low specificity of the different D-dimer tests in contrast to its frequent usage, adequate interpretation is required. Age-related adjustment of D-dimer levels may be used to increase its diagnostic power.

A non-cardiac cause of an abnormal ECG

2009 ◽  
Vol 8 (2) ◽  
pp. 70-72
Author(s):  
Mohamed Abdulhadi ◽  
◽  
Gamal Alfitori ◽  
Peter Mennim ◽  
◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Pilocytic Astrocytoma ◽  
Neurological Diseases ◽  
Coronary Syndrome ◽  
Electrocardiographic Changes ◽  
Time Of Presentation ◽  
Electrocardiographic Abnormalities ◽  
Space Occupying Lesion

Abnormalities of the electrocardiogram are extremely useful for the diagnosis of heart disease, but they may also occur in non-cardiac conditions. The electrocardiographic abnormalities that have been described in neurological diseases are among the most striking deviations from normal. We describe a patient with an intracranial space occupying lesion (pilocytic astrocytoma) who exhibited electrocardiographic changes suggestive of acute coronary syndrome at the time of presentation with syncope.

scholarly journals The Association of Electrocardiographic Abnormalities and Acute Coronary Syndrome in Emergency Patients With Chest Pain

2017 ◽  
Vol 24 (3) ◽  
pp. 344-352 ◽  
Author(s):  
Thomas Knowlman ◽  
Jaimi H. Greenslade ◽  
William Parsonage ◽  
Tracey Hawkins ◽  
Lorcan Ruane ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Emergency Patients ◽  
Coronary Syndrome ◽  
Electrocardiographic Abnormalities

scholarly journals Google Trends Insights Into Reduced Acute Coronary Syndrome Admissions During the COVID-19 Pandemic: Infodemiology Study (Preprint)

2020 ◽  
Author(s):  
Conor Senecal ◽  
Rajiv Gulati ◽  
Amir Lerman
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Chest Pain ◽  
Emergency Room ◽  
Google Trends ◽  
Coronary Syndrome ◽  
Search Terms ◽  
Pain Symptoms

BACKGROUND During the coronavirus disease (COVID-19) pandemic, a reduction in the presentation of acute coronary syndrome (ACS) has been noted in several countries. However, whether these trends reflect a reduction in ACS incidence or a decrease in emergency room visits is unknown. Using Google Trends, queries for chest pain that have previously been shown to closely correlate with coronary heart disease were compared with searches for myocardial infarction and COVID-19 symptoms. OBJECTIVE The current study evaluates if search terms (or topics) pertaining to chest pain symptoms correlate with the reported decrease in presentations of ACS. METHODS Google Trends data for search terms “chest pain,” “myocardial infarction,” “cough,” and “fever” were obtained from June 1, 2019, to May 31, 2020. Related queries were evaluated for a relationship to coronary heart disease. RESULTS Following the onset of the COVID-19 pandemic, chest pain searches increased in all countries studied by at least 34% (USA <i>P</i>=.003, Spain <i>P</i>=.007, UK <i>P</i>=.001, Italy <i>P</i>=.002), while searches for myocardial infarction dropped or remained unchanged. Rising searches for chest pain included “coronavirus chest pain,” “home remedies for chest pain,” and “natural remedies for chest pain.” Searches on COVID-19 symptoms (eg, cough, fever) rose initially but returned to baseline while chest pain–related searches remained elevated throughout May. CONCLUSIONS Search engine queries for chest pain have risen during the pandemic as have related searches with alternative attribution for chest pain or home care for chest pain, suggesting that recent drops in ACS presentations may be due to patients avoiding the emergency room and potential treatment in the midst of the COVID-19 pandemic.

scholarly journals Google Trends Insights Into Reduced Acute Coronary Syndrome Admissions During the COVID-19 Pandemic: Infodemiology Study

JMIR Cardio ◽  
10.2196/20426 ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. e20426
Author(s):  
Conor Senecal ◽  
Rajiv Gulati ◽  
Amir Lerman
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Chest Pain ◽  
Emergency Room ◽  
Google Trends ◽  
Coronary Syndrome ◽  
Search Terms ◽  
Pain Symptoms

Background During the coronavirus disease (COVID-19) pandemic, a reduction in the presentation of acute coronary syndrome (ACS) has been noted in several countries. However, whether these trends reflect a reduction in ACS incidence or a decrease in emergency room visits is unknown. Using Google Trends, queries for chest pain that have previously been shown to closely correlate with coronary heart disease were compared with searches for myocardial infarction and COVID-19 symptoms. Objective The current study evaluates if search terms (or topics) pertaining to chest pain symptoms correlate with the reported decrease in presentations of ACS. Methods Google Trends data for search terms “chest pain,” “myocardial infarction,” “cough,” and “fever” were obtained from June 1, 2019, to May 31, 2020. Related queries were evaluated for a relationship to coronary heart disease. Results Following the onset of the COVID-19 pandemic, chest pain searches increased in all countries studied by at least 34% (USA P=.003, Spain P=.007, UK P=.001, Italy P=.002), while searches for myocardial infarction dropped or remained unchanged. Rising searches for chest pain included “coronavirus chest pain,” “home remedies for chest pain,” and “natural remedies for chest pain.” Searches on COVID-19 symptoms (eg, cough, fever) rose initially but returned to baseline while chest pain–related searches remained elevated throughout May. Conclusions Search engine queries for chest pain have risen during the pandemic as have related searches with alternative attribution for chest pain or home care for chest pain, suggesting that recent drops in ACS presentations may be due to patients avoiding the emergency room and potential treatment in the midst of the COVID-19 pandemic.

Viral Heart Disease and Acute Coronary Syndromes - Often or Rare Coexistence?

2018 ◽  
Vol 24 (4) ◽  
pp. 532-540
Author(s):  
Agnieszka Pawlak ◽  
Natalia Wiligorska ◽  
Diana Wiligorska ◽  
Malgorzata Frontczak–Baniewicz ◽  
Maciej Przybylski ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Coronary Arteries ◽  
Inflammatory Process ◽  
Clinical Presentation ◽  
Antiviral Treatment ◽  
Atherosclerotic Plaques ◽  
Imaging Features ◽  
Coronary Syndrome ◽  
Viral Heart Disease

Background: Clinical presentation of viral myocarditis can mimic acute coronary syndrome and making diagnosis of viral heart disease (VHD) may be challenging. The presence of coronary artery disease (CAD) does not always exclude VHD and these entities can coexist. However, the incidence of co-occurrence of CAD and VHD is not precisely known. Moreover, inflammatory process caused by viruses may result in atherosclerotic plaque destabilization. Methods: The goal of this work is to summarize the current knowledge about co-occurrence of VHD and CAD. This article presents the importance of inflammatory process in both diseases and helps to understand pathophysiological mechanisms underlying their coexistence. It provides information about making differential diagnosis between these entities, including clinical presentation, noninvasive imaging features and findings in endomyocardial biopsy. Although currently there are no standard therapy strategies in coexistence of VHD and CAD, we present some remarkable aspects of treatment of patients, in whom VHD co-occurs with CAD. Results: Viral heart disease may occur both in patients without and with atherosclerotic plaques in coronary arteries. Destabilization of atherosclerotic plaques in coronary arteries can be facilitated by inflammatory process. Increased inflammatory infiltrates in the coronary lesions of patients with VHD can lead to plaques’ instability and consequently trigger acute coronary syndrome. Conclusion: In this article we attempted to present that co-occurrence of VHD and CAD may have therapeutic implications and as specific antiviral treatment is currently available, proper diagnosis and treatment can improve patient’s condition and prognosis.

scholarly journals A128 ACUTE GASTRIC VOLVULUS DISGUISED AS ACUTE CORONARY SYNDROME.

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 111-112
Author(s):  
J G Lee ◽  
E Nap-Hill ◽  
B Bressler
Keyword(s):  
Acute Coronary Syndrome ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Bypass Graft ◽  
Gastric Volvulus ◽  
Anastomotic Site ◽  
Intrathoracic Stomach ◽  
Coronary Syndrome ◽  
Acute Gastric Volvulus ◽  
History Of

Abstract Background Acute gastric volvulus is a rare but potentially life-threatening condition that warrants emergent assessment. Its clinical presentation may encompass the Borchardt’s triad of vomiting, epigastric pain, and inability to insert a nasogastric tube. However, it can also present as chest pain and is often not cited within the typical differential diagnosis of non-cardiac causes of chest pain. We report the first known case of mesenterico-axial gastric volvulus presenting as acute coronary syndrome with a normal electrocardiogram, complete with radiographic and endoscopic images. Aims To present a case of acute gastric volvulus disguised as an acute coronary syndrome and describe its management. Methods Case report and review of literature. Results A 68 year-old female with history of recent coronary artery bypass graft surgery presented to hospital with sudden onset chest pain radiating to her left shoulder and jaw while having dinner. Initial high sensitivity troponin (normal &lt;9ng/L) was 15ng/L, which increased to a modest peak at 115ng/L. ECG at presentation and through admission consistently showed normal sinus rhythm x 5. She was assessed by Cardiology and given her rising troponin and chest pain, she was treated as a non-ST elevation myocardial infarction with dual antiplatelet therapy. She underwent cardiac catheterization showing distal graft anastomotic site stenosis and was stented x2. Post procedure, her severe retrosternal chest pain recurred. GI was consulted for dysphagia and odynophagia, which was then noted to be present concurrent with her initial chest pain presentation. An urgent CT scan of the abdomen and pelvis revealed acute mesenterico-axial gastric volvulus (Figure 1A), a rarer form of gastric volvulus in the adult population compared to its organo-axial counterpart. After a failed nasogastric decompression, an emergent upper endoscopy was attempted and demonstrated mucosal necrosis (Figure 1B) but was unsuccessful in relieving the volvulus. The patient then underwent overnight surgery, which showed gastric volvulus with contained perforation and 50% necrosis of the stomach with sparing of the cardia and antrum. This resulted in a subtotal gastrectomy, hiatus hernia repair, pyloromyotomy, jejunostomy, and bilateral chest tube insertion. She then recovered in ICU before being successfully discharged home from hospital. Conclusions Acute gastric volvulus can present while disguised as more common causes of chest pain, such as acute coronary syndrome. Those who present with chest pain who also have a history of a large hiatal hernia, or an intrathoracic stomach should be evaluated with gastric volvulus in the differential diagnosis as its prompt management is critical to reduce morbidity and mortality. Funding Agencies None

scholarly journals Pheochromocytoma presenting as a mimic of acute coronary syndrome

2016 ◽  
Vol 15 (3) ◽  
pp. 145-148
Author(s):  
Yasmin Hakim ◽  
◽  
Anna Forbes ◽  
Momina Khan ◽  
Benjamin C Whitelaw ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Adrenal Mass ◽  
Troponin I ◽  
Clinical Presentation ◽  
Elevated Serum ◽  
Coronary Syndrome ◽  
Crisis Events ◽  
Common Clinical Presentation ◽  
Patient At Risk

Chest pain with elevated serum troponin is a common clinical presentation and is normally managed as suspected myocardial infarction or acute coronary syndrome (ACS). We report a 49 year old man who presented with central chest pain sweating and breathlessness. He had a significantly elevated serum troponin I level and a subsequent angiogram showed near normal coronary arteries. He was subsequently investigated for fever and found to have a 3cm right sided adrenal mass consistent with a pheochromocytoma. After confirmation and appropriate blockade laparoscopic adrenalectomy was performed. Pheochromocytoma may present as a mimic of acute coronary syndrome but this is often unrecognized and leaves the patient at risk of future pheo crisis events which may be fatal.

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